OVERVIEW
Biliary Giardiasis is an inflammatory disease caused by Giardia lamblia infesting the biliary system. Giardia lamblia, referred to as Giardia, has a worldwide distribution, with a life history divided into two stages: trophozoite and encapsulated, and the main source of infection is the encapsulated fecal matter. All age groups can be infected, infants, young children, the elderly and immunocompromised people are susceptible.
Etiology
The disease is mostly caused by ingestion of food or water contaminated by Giardia, and fecal-oral transmission is the main way of infection.
Symptoms
The main manifestations are pain in the right upper abdomen or subglabellar region, lack of appetite and nausea, and pressure pain in the right upper abdomen. Mild elevation of aminotransferases and jaundice may be present in some patients.
Examination
1. Pathogen examination
Encapsulated trophozoites or trophozoites can be seen in feces or small intestinal contents, and trophozoites can be detected in duodenal drainage fluid or endoscopic biopsy of duodenal mucosa.
2. Immunological tests
There are two types of tests: serum antibody and fecal antigen.
(1) Antibody test: Enzyme-linked immunosorbent assay (ELISA) and indirect fluorescent antibody test (IFA) can be used to check patients’ serum antibodies.
(2) Antigen detection: Enzyme-linked immunosorbent assay (double antibody sandwich method), spot enzyme-linked immunosorbent assay (dot-ELISA), convection immunoelectrophoresis can be used to detect antigens in fecal dilutions, which is not only used for diagnosis, but also for observing the efficacy of treatment.
3. Molecular biology diagnosis
Detection of Giardia ribosomal RNA gene products by polymerase chain reaction can detect amplified copies equivalent to one trophozoite genomic DNA. Radionuclide-labeled chromosomal DNA probes can also be used to detect trophozoites and capsules.
4. Other tests
Abdominal ultrasound can be performed to find out the condition of the liver and gallbladder. Chest X-ray and electrocardiogram are also required.
Diagnosis
1. Gastrointestinal inflammation, cholecystitis, cholangitis symptoms, blood eosinophilia.
2. Giardia is detected in duodenal drainage fluid.
3. Positive test for Giardia antigen and antibody.
4. biliary system inflammation seen on imaging.
Treatment
1. Isolation and dietary control with reference to intestinal infectious diseases.
2. Drug treatment, commonly used metronidazole, tinidazole, praziquantel and baloneycin.
3. Antibiotic treatment should be given to patients with combined bacterial infection.